Moving towards the goals of FP2020 - classifying contraceptives.

With the renewed focus on family planning, a clear and transparent understanding is needed for the consistent classification of contraceptives, especially in the commonly used modern/traditional system. The World Health Organization Department of Reproductive Health and Research and the United States Agency for International Development (USAID) therefore convened a technical consultation in January 2015 to address issues related to classifying contraceptives. The consultation defined modern contraceptive methods as having a sound basis in reproductive biology, a precise protocol for correct use and evidence of efficacy under various conditions based on appropriately designed studies. Methods in country programs like Fertility Awareness Based Methods [such as Standard Days Method (SDM) and TwoDay Method], Lactational Amenorrhea Method (LAM) and emergency contraception should be reported as modern. Herbs, charms and vaginal douching are not counted as contraceptive methods as they have no scientific basis in preventing pregnancy nor are in country programs. More research is needed on defining and measuring use of emergency contraceptive methods, to reflect their contribution to reducing unmet need. The ideal contraceptive classification system should be simple, easy to use, clear and consistent, with greater parsimony. Measurement challenges remain but should not be the driving force to determine what methods are counted or reported as modern or not. Family planning programs should consider multiple attributes of contraceptive methods (e.g., level of effectiveness, need for program support, duration of labeled use, hormonal or nonhormonal) to ensure they provide a variety of methods to meet the needs of women and men.

Reducing unintended pregnancies: a microsimulation of contraceptive switching, discontinuation, and failure patterns in france.

Although the rate of contraceptive use in France is high, more than one-third of pregnancies are unintended. We built a dynamic microsimulation model that applies data from the French COCON study on method switching, discontinuation, and failure rates to a hypothetical population of 20,000 women, followed for five years. We use the model to estimate the adjustment factor needed to make the survey data fit the demographic profile of France by adjusting for underreporting of contraceptive nonuse and abortion. We then test three behavior-change scenarios that could reduce unintended pregnancies: decreasing method failure, increasing time using effective methods, and increasing switching from less effective to more effective methods. Our model suggests that decreasing method failure is the most effective means of reducing unintended pregnancies, but we found that all of the scenarios reduced unintended pregnancies by at least 25 percent. Dynamic microsimulations may have great potential in reproductive health research and prove useful for policymakers.

Enhancing contraception: a comprehensive review.

This review covers familiar and emerging contraceptive methods, comparing the risks and benefits of each. These basics will help you connect patients with the most acceptable form of contraception for them.

Obstetric and gynecology devices; effective date of requirement for premarket approval for glans sheath devices. Final rule.

The Food and Drug Administration (FDA) is issuing a final rule to require the filing of a premarket approval application (PMA) or a notice of completion of product development protocol (PDP) for glans sheath medical devices. The agency has previously published its findings regarding the degree of risk of illness or injury designed to be eliminated or reduced by requiring the devices to meet the statute's approval requirements and the benefits to the public from the use of the devices.

Utilización de los métodos anticonceptivos de las usuarias del Hospital Materno Infantil San Pablo

Estudio descriptivo de los métodos utilizados por las mujeres que acuden al servicio de Planificación Familiar del Hospital Materno Infantil San Pablo. Describe los métodos anticonceptivos más utilizados, sus beneficios, riesgos y tratamientos

Mujer, frontera, inserción laboral y comportamiento reproductivo

Estudio descriptivo cuantitativo de la situación social ocupacional de las mujeres en la frontera Alberdi Formosa y los aspectos vinculados a su salud y comportamiento reproductivos

[Vaginal and intrauterine contraception]. / Contraception vaginale et intra-utérine.

Vaginal contraception (condom, diaphragm and spermicide in pessary, tablet, jelly, cream, or sponge form) have been little used in France and generally in Europe since the advent of modern contraception with "the pill" and the intrauterine contraceptive device. The former methods, when properly used, are nevertheless both effective and useful, at least as interim measures. In addition, the protection they afford against sexually transmitted diseases and, for the condom, against HIV, is not negligible. Finally, the "barrier" methods of contraception such as the diaphragm and the condom afford significant protection against cancer of the cervix. The intrauterine contraceptive device (IUCD), used in France by 14% of women between 15 and 49 years of age and by 90 million women throughout the world for whom it is the main reversible means of contraception, have a mechanism of action that is still not fully understood. Most IUCD now used are made of copper. There are also diffusion IUCD based on progesterone or a synthetic progestational hormone which are useful in case of anaemia, menorrhagia or dysmenorrhea.

PIP: With the introduction of modern contraceptives (i.e., oral contraceptives and IUDs), women in France as well as those in Europe in general tend not to use vaginal contraceptives as their principal contraceptive method. Vaginal contraceptives include the condom, diaphragm, and spermicide in the form of a pessary, tablet, jelly, cream, or sponge. When vaginal contraceptives are used correctly, they have an acceptable efficacy and are useful, at least as interim methods. It is important to also consider their part in protecting against sexually transmitted diseases and HIV. Further, the vaginal barrier methods, the condom and the diaphragm, provide significant protection against cervical cancer. 14% of women aged 15-49 in France and 90 million women worldwide use the IUD. Worldwide, the IUD is the primary reversible contraceptive method used. The contraceptive mode of action of the IUD is not yet clearly understood. The most popular IUD is the copper-releasing IUD. The IUD releasing progesterone or a synthetic progestin is useful in treating anemia, menorrhagia, or dysmenorrhea.

Métodos Anticonceptivos / Anticonceptive methods

Los métodos anticonceptivos son los recursos y procedimientos que se utilizan con el fin de evitar la unión del óvulo o gameto femenino con el espermatozoide o gameto masculino, y que permiten la cópula entre la pareja sin el riesgo de embarazo. Los métodos anticonceptivos se clasifican en temporales y permanentes. De los primeros se destaca lo siguiente, los hormonales, elaborados con base en hormonas sintéticas derivadas de los estrógenos y la progesterona que administradas regularmente, son capaces de evitar el embarazo, existen dos vias de administracion la forma oral y la forma inyectable; los dispositivos intrauterino que son objetos de forma, tamaño y material diferentes, adecuados para ser colocados en la cavidad uterina con el fin de evitar el embarazo; los métodos de barrera que son agentes mécanicos o substancias químicas que sirven para impedir que los espermatozoides alcancen la cavidad uterina y fecunden el óvulo, entre ellos se encuentran el preservativo, los espermaticidas y los óvulos vaginales; los métodos naturales son aquellos que no requieren de ningún agente extraño o substancia química que impida la concepción, entre ellos se encuentran: el ritmo o abstinencia sexual programada y el coito interrumpido. Los métodos permanentes son la oclusión tubaria bilateral y la vasectomía. En todos los casos antes referidos se anotan las indicaciones, las contraindicaciones, las ventajas, desventajas y efectividad

Recent developments in barrier methods of contraception.

PIP: Women have used contraceptive barriers for centuries, such as leaves, to prevent pregnancy and sexually transmitted diseases (STDs). Spermicides are used with at least 3 of the 5 modern female barrier methods -- the diaphragm, the cap, and the sponge. The thin domed rubber diaphragms lie diagonally across the cervix, the vault, and part of the anterior vaginal wall. Suction holds the cervical/vault caps in place. Women must be fitted for these 2 methods before use. Women can buy a small polyurethane sponge impregnated with 1 gram of nonoxynol-9 spermicide to cover the cervix over the counter. It has a high failure rate, however, since adequate instructions for insertion are not provided. The vaginal ring is not designed to fit into 1 fixed position in the vagina, yet probably spends most of its time in the posterior fornix. The ring continuously releases the levonorgestrel or a spermicide. The recently developed vaginal shield or female sheath has promise. It is a hollow tube made of strong elastic polyurethane. Since the era of the ancient Romans and Egyptians, men have used barriers made of such diverse material as animal bladders, silk, and lamb intestine, to protect against dirt and disease or for decoration. Condoms were 1st manufactured in the 1900s and had to be washed and dried following each act of intercourse. With the increase in STDs during World War II, condom distribution to the troops became standard practice. Today condoms come in a variety of colors, lengths, and strengths. Some have been coated with the spermicide nonoxynol-9 which protects against STDs. The condom follows oral contraceptives as the most popular form of contraceptive in the United Kingdom. A 1987 television campaign to promote barrier method use in light of the AIDS epidemic backfired. For example, it implied that diaphragms and sponges protect women from HIV.^ieng

A multi-compartment vaginal ring system for independently adjustable release of contraceptive steroids.

A multi-compartment contraceptive vaginal ring system has been designed for the simultaneous zero-order release of contraceptive steroids, the rates of which can be programmed independently. This vaginal ring system consists of two or more drug-containing Silastic tubes with an outer diameter of 5 mm. The tubes with different lengths, with a total length of 16.5 cm are connected with specially-shaped glass stoppers to obtain a ring with an outer diameter of 60 mm. The stopper prevents migration of the steroids from one compartment to the other and guarantees optimal release characteristics of both steroids even after long-term storage. An additional advantage of glass is the good adherence to Silastic, enabling construction of systems with sufficient tensile strength. The release characteristics have been followed in vitro and can be programmed independently by changing the wall thickness of the tube (membrane thickness) and/or the length of each individual steroid-containing compartment. Multicompartment vaginal rings were made and tested with 3-keto-desogestrel and ethinylestradiol. The rings had an outer diameter of 60 mm, and were fabricated with independent in vitro release rates ranging from 75 to 300 micrograms/day and 10 to 30 micrograms/day for, respectively, 3-keto-desogestrel and ethinylestradiol. Using the multi-compartment vaginal ring system, contraceptive devices can be fabricated relatively simply with pre-programmed release rates for a progestogen and an estrogen to investigate the optimal daily doses for vaginal hormonal contraception.

PIP: A multi-compartment contraceptive vaginal ring system has been designed for the simultaneous zero-order release of contraceptive steroids, the rates of which can be programmed independently. This vaginal ring system consists of 2 or more drug-containing Silastic tubes with an outer diameter of 5 mm. The tubes with different lengths, with a total length of 16.5 cm are connected with specially-shaped glass stoppers to obtain a ring with an outer diameter of 60 mm. The stopper prevents migration of the steroids from 1 compartment to the other and guarantees optimal release characteristics of both steroids even after long-term storage. An additional advantage of glass is the good adherence to Silastic, enabling construction of systems with sufficient tensile strength. The release characteristics have been followed in vitro and can be programmed independently by changing the wall thickness of the tube (membrane thickness) and/or the length of each individual steroid-containing compartment. Multi-compartment vaginal rings were made and tested with 3-ketodesogestrel and ethinylestradiol.

[What type of contraceptive method can the physician recommend?]. / Welche kontrazeptive Methode kann der Arzt empfehlen.

Contraceptives should be reliable, innocuous and compatible. With reference to their reliability (Pearl-index) they can be devided into four groups. Only the oral contraceptives can be classified as "reliable". The risk of women over 40 for myocardial infarction is only barely raised by the pill according to new data. "Relatively reliable" are intrauterine devices, the mini-pill, the temperature method and the foam ovula containing 4 p-Nonyphenoxypolyethylenglycol. Failures are ten times as frequent as with the oral contraceptives. Adnexitis caused by intrauterine devices ist seven times more frequent in nulliparae than in the average female population. Among oral contraceptives, the mini-pill is the only one without appreciable side-effects, risks, or contraindications. Grade three preventives ("medium reliability") should be used for child spacing. The fourth group of unreliable methods comprises the Knaus-Ogino method, coitus interruptus and the long-established chemical preventives.